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Gambashidze N, Marsall M, Schmiedhofer M, Blum K, Roesner H, Strametz R, Weigl M. Development and validation of a short clinical risk management implementation (Short CRiMI) questionnaire. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 187:8-14. [PMID: 38762346 DOI: 10.1016/j.zefq.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/29/2024] [Accepted: 04/25/2024] [Indexed: 05/20/2024]
Abstract
Clinical Risk Management (CRM) is an important instrument to continuously improve safety of health care delivery. In Germany, hospitals are required by law to implement CRM and incidence reporting systems. Since 2010, nation-wide surveys have been conducted periodically to evaluate implementation of CRM in hospitals. The instrument used in these surveys is constantly being updated to reflect previous experiences, as well as to adapt to ongoing trends and developments in CRM practices. The survey instrument used in 2022 consisted of up to 200 items and took up to an hour to complete. In this study, we aimed to develop a short instrument to measure the level of CRM implementation in hospitals, evaluate its psychometric properties, and to offer benchmarking data for health care facilities of different sizes. We used data collected in 2022 as part of KHaSiMiR study, employing a cross-sectional self-reported online survey. The hospital administrations were invited to designate one CRM manager to participate in the study. Out of 1,411 general hospitals invited, 401 responses were collected (response rate of 28%). After removing the cases with excessive missings, we imputed remaining missing values using multiple imputation, and split the resulting sample (n=362) in two halves (i.e., exploratory and testing subsamples). A principal component analysis was applied on the first subsample. We validated the resulting model using confirmatory factor analysis in the testing subsample. We evaluated internal consistency, and tested external validity of the established instrument using correlation analysis with two single-item measures: subjective evaluation of CRM implementation compared to similar organizations and compared to own ideal level. The principal component analysis included 45 items from the full instrument. The analysis resulted in a three-factor model with 26 items. In the confirmatory factor analysis, the model demonstrated acceptable fit with the data according to the commonly used fit indices: Chi2/df=1.36, CFI=0.941, TLI=0.930, RMSEA=0.045 (90% CI=0.032-0.056), SRMR=0.049. Cronbach's alpha of all three factors was good (>0.70). All three factors had statistically significant positive correlations with each other (0.359-0.497) and with the two single items (0.282-0.532). None of the correlations were high enough (>0.7) to indicate multicollinearity. The proposed short clinical risk management implementation (Short CRiMI) questionnaire is psychometrically valid and can be used to rapidly evaluate CRM implementation in hospitals. Further research can provide evidence of its external validity and association with quality and safety outcomes. Benchmarking data can be used to compare the results with the data from the most recent Germany-wide survey.
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Affiliation(s)
| | - Matthias Marsall
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Martina Schmiedhofer
- German Coalition for Patient Safety (Aktionsbündnis Patientensicherheit e.V.), Berlin, Germany
| | - Karl Blum
- Deutsches Krankenhausinstitut, Düsseldorf, Germany
| | - Hannah Roesner
- Wiesbaden Institute for Healthcare Economics and Patient Safety, Wiesbaden Business School, RheinMain University of Applied Sciences, Wiesbaden, Germany
| | - Reinhard Strametz
- Wiesbaden Institute for Healthcare Economics and Patient Safety, Wiesbaden Business School, RheinMain University of Applied Sciences, Wiesbaden, Germany
| | - Matthias Weigl
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
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Buchberger W, Schmied M, Schomaker M, Del Rio A, Siebert U. Implementation of a comprehensive clinical risk management system in a university hospital. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 184:18-25. [PMID: 38199940 DOI: 10.1016/j.zefq.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Adverse events during hospital treatment are common and can lead to serious harm. This study reports the implementation of a comprehensive clinical risk management system in a university hospital and assesses the impact of clinical risk management on patient harms. METHODS The clinical risk management system was rolled out over a period of eight years and consisted of a training of interdisciplinary risk management teams, external and internal risk audits, and the implementation of a critical incident reporting system (CIRS). The risks identified during the audits were analyzed according to the type, severity, and implementation of preventive measures. Other key figures of the risk management system were obtained from the annual risk reports. The number of liability cases was used as primary outcome measurement. RESULTS Of the 1,104 risks identified during the risk audits, 56.2% were related to organization, 21.3% to documentation, 15.3% to treatment, and 7.2% to patient information and consent. The highest proportion of serious risks was found in the category organization (22.7%), the lowest in the category documentation (13.6%). Critical incident reporting identified between 241 and 370 critical incidents per year, for which in 79.5% to 83% preventive measures were implemented within twelve months. The frequency of incident reports per department correlated with the number of active risk managers and risk team meetings. Compared with the years prior to the introduction of the clinical risk management system, an average annual reduction of harms by 60.1% (95% CI: 57.1; 63.1) was observed two years after the implementation was completed. On average, the rate of harms dropped by 5% per year for each 10% increase in roll-out of the clinical risk management system (incidence rate ratio: 0.95; 95% CI: 0.93; 0.97) . CONCLUSION The results of this project demonstrate the effectiveness of clinical risk management in detecting treatment-related risks and in reducing harm to patients.
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Affiliation(s)
- Wolfgang Buchberger
- UMIT TIROL- University for Health Sciences and Technology, Institute of Public Health, Medical Decision Making and HTA, Hall in Tirol, Austria.
| | - Marten Schmied
- UMIT TIROL- University for Health Sciences and Technology, Institute of Nursing Science, Hall in Tirol, Austria
| | - Michael Schomaker
- Ludwig-Maximilians-Universität München, Department of Statistics, Munich, Germany; University of Cape Town, Centre of Infectious Disease Epidemiology and Research, Cape Town, South Africa
| | - Anca Del Rio
- Strategy and Global Development Advisor, EIT Health Germany-Switzerland, Munich, Germany
| | - Uwe Siebert
- UMIT TIROL- University for Health Sciences and Technology, Institute of Public Health, Medical Decision Making and HTA, Hall in Tirol, Austria; Harvard T.H. Chan School of Public Health, Center for Health Decision Science and Departments of Epidemiology and Health Policy & Management, Boston, MA, USA; Massachusetts General Hospital, Harvard Medical School, Institute for Technology Assessment and Department of Radiology, Boston, MA, USA
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Baehr A, Hummel D, Gauer T, Oertel M, Kittel C, Löser A, Todorovic M, Petersen C, Krüll A, Buchgeister M. Risk management patterns in radiation oncology-results of a national survey within the framework of the Patient Safety in German Radiation Oncology (PaSaGeRO) project. Strahlenther Onkol 2023; 199:350-359. [PMID: 35931889 PMCID: PMC10033570 DOI: 10.1007/s00066-022-01984-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Risk management (RM) is a key component of patient safety in radiation oncology (RO). We investigated current approaches on RM in German RO within the framework of the Patient Safety in German Radiation Oncology (PaSaGeRO) project. Aim was not only to evaluate a status quo of RM purposes but furthermore to discover challenges for sustainable RM that should be addressed in future research and recommendations. METHODS An online survey was conducted from June to August 2021, consisting of 18 items on prospective and reactive RM, protagonists of RM, and self-assessment concerning RM. The survey was designed using LimeSurvey and invitations were sent by e‑mail. Answers were requested once per institution. RESULTS In all, 48 completed questionnaires from university hospitals, general and non-academic hospitals, and private practices were received and considered for evaluation. Prospective and reactive RM was commonly conducted within interprofessional teams; 88% of all institutions performed prospective risk analyses. Most institutions (71%) reported incidents or near-events using multiple reporting systems. Results were presented to the team in 71% for prospective analyses and 85% for analyses of incidents. Risk conferences take place in 46% of institutions. 42% nominated a manager/committee for RM. Knowledge concerning RM was mostly rated "satisfying" (44%). However, 65% of all institutions require more information about RM by professional societies. CONCLUSION Our results revealed heterogeneous patterns of RM in RO departments, although most departments adhered to common recommendations. Identified mismatches between recommendations and implementation of RM provide baseline data for future research and support definition of teaching content.
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Affiliation(s)
- Andrea Baehr
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany.
| | - Daniel Hummel
- Department of Radiotherapy and Genetics, Outpatient Center Stuttgart, University Hospital Tübingen, Stuttgart, Germany
| | - Tobias Gauer
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Oertel
- Department of Radiation Oncology, University Hospital Münster, Münster, Germany
| | - Christopher Kittel
- Department of Radiation Oncology, University Hospital Münster, Münster, Germany
| | - Anastassia Löser
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Manuel Todorovic
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cordula Petersen
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Krüll
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Buchgeister
- Faculty of Mathematics-Physics-Chemistry (II), Berliner Hochschule für Technik, Berlin, Germany
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Glarcher M, Kaiser K, Nestler N, Kutschar P. Psychometric Properties of the Safety Climate Survey in Austrian Acute Care: Factor Structure, Reliability, and Usability. J Patient Saf 2022; 18:193-200. [PMID: 34347738 PMCID: PMC9359777 DOI: 10.1097/pts.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospitals are complex organizations with a potential for medical errors that can be influenced by safety culture. Safety climate, as measurable element of safety culture, illustrates the perception of safety-relevant aspects of health care staff at a certain time. The Safety Climate Survey is applied internationally to measure safety climate. However, psychometrics for the German version of the survey have yet not been evaluated. The aim of this study is to explore the factor structure, reliability, and potential usefulness of the Safety Climate Survey in Austrian acute care. METHODS Cross-sectional surveys of physicians, therapists, and nurses/midwives were implemented. An exploratory factor analysis was carried out, both in total sample and split by 2 selected professions. After deriving a factor structure for both professions, internal consistency and scale means were calculated for the subscales. Finally, mean subscale differences between physicians and nurses/midwives were tested. RESULTS Of 5160 eligible staff, 933 respondents participated. A 6-factor solution explaining 59.1% of total variance was identified. Comparison by profession illustrated that the factor structures and item loading patterns differ between physicians and nurses/midwives. To achieve an overarching solution, 5 items were excluded from consecutive subscale measures because of cross-loadings and contradictory factor loadings. Subscales demonstrated good to low internal consistency (α = 0.794-0.535). Significant mean differences between subscales of professions were found relating to 3 factors. CONCLUSIONS The German Safety Climate Survey measures safety climate multidimensionally rather than unidimensionally and demonstrated some limitations in factor structures and item loadings but overall had satisfactory reliability of the 6 subscales.
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Affiliation(s)
- Manela Glarcher
- From the Paracelsus Medical University, Institute of Nursing Science and Practice, Salzburg, Austria
| | - Karin Kaiser
- From the Paracelsus Medical University, Institute of Nursing Science and Practice, Salzburg, Austria
| | - Nadja Nestler
- From the Paracelsus Medical University, Institute of Nursing Science and Practice, Salzburg, Austria
| | - Patrick Kutschar
- From the Paracelsus Medical University, Institute of Nursing Science and Practice, Salzburg, Austria
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Glarcher M, Kaiser K, Kutschar P, Nestler N. Safety climate in hospitals: A cross-sectional study on the perspectives of nurses and midwives. J Nurs Manag 2022; 30:742-749. [PMID: 35088479 PMCID: PMC9314869 DOI: 10.1111/jonm.13551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/07/2021] [Accepted: 01/24/2022] [Indexed: 12/04/2022]
Abstract
Aims To explore nurses' and midwives' perspectives of safety climate in Austrian hospitals as measurable elements of safety culture and to identify areas of quality improvement. Background Due to close contact with patients, nurses and midwives play a vital role in ensuring patient safety. Method An online survey among 713 nurses and midwives was conducted, using the 19‐item Safety Climate Survey (SCS). To answer the survey, a 5‐point Likert scale was provided with higher ratings indicating a more positive safety climate. Results Results demonstrate a positive safety culture (MD 4.09, SD 0.53). Significant group differences in overall safety climate score could be found regarding nurses and midwives in managerial positions, between gender and participants age with low effect size. High item missing rates focus aspects on management/leadership, institutional concerns, leadership by physicians, and handling of adverse events. In addition, these items present the lowest ratings in safety climate. Conclusion Results indicate potentials for optimization in the areas of leadership communication and feedback, the handling of safety concerns, and visibility or improvement of patient safety strategies. Implications for Nursing Management A regular, standardized safety climate measurement can be a valuable tool for nurse managers and (political) decision‐makers to manage patient safety initiatives.
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Affiliation(s)
- Manela Glarcher
- Paracelsus Medical University, Institute of Nursing Science and Practice, Austria
| | - Karin Kaiser
- Paracelsus Medical University, Institute of Nursing Science and Practice, Austria
| | - Patrick Kutschar
- Paracelsus Medical University, Institute of Nursing Science and Practice, Austria
| | - Nadja Nestler
- Paracelsus Medical University, Institute of Nursing Science and Practice, Austria
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Using failure mode and Effects Analysis to increase patient safety in cancer chemotherapy. Res Social Adm Pharm 2021; 18:3386-3393. [PMID: 34838476 DOI: 10.1016/j.sapharm.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/16/2021] [Accepted: 11/16/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Medication errors may occur during chemotherapy and can have fatal consequences. Healthcare Failure Mode and Effects Analysis (FMEA) is a method used to detect potential risks and prevent them. OBJECTIVE Aim of this study was to evaluate the medication process of intravenous tumor therapy in order to guarantee a high standard of patient safety. METHODS The main part of the study was performed at the University Hospital of Bonn, Germany. After assembling a multidisciplinary team, the individual steps of prescription, compounding, transport, and administration of chemotherapy were mapped in a flow diagram. The possible failures were identified and analyzed by calculating the risk priority numbers (RPNs). Finally, corrective actions were developed and after hypothetical implementation re-analyzed to measure their effects on the process. Subsequently, a shortened FMEA based on the catalogue failure modes developed in Bonn was carried out at the University Hospital of Cologne in order to evaluate its transferability to another hospital. RESULTS A total of 52 potential failure modes was identified in Bonn. Relating to the RPNs the most critically steps in the process were associated with the prescription, namely, incorrect information about individual parameters of the patient; non-standardized chemotherapy protocols; and problems related to supportive therapy. A significant risk reduction for most of the failure modes was assessed by implementing suitable corrective actions. The shortened FMEA in Cologne led to a different ranking of failure modes. CONCLUSION The implementation of this analysis has not only identified various safety gaps, but also shows how patient safety during chemotherapy can be enhanced. Moreover, it has sensitized the practitioners to failure modes potentially occurring in their work routine.
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Höppchen I, Ullrich C, Wensing M, Poß-Doering R, Suda AJ. [Safety culture in orthopedics and trauma surgery : A qualitative study of the physicians' perspective]. Unfallchirurg 2021; 124:481-488. [PMID: 33170311 PMCID: PMC8159809 DOI: 10.1007/s00113-020-00917-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hintergrund Krankenhäuser in Deutschland betreiben ein Risikomanagement, welches die Prävention und systematische Aufarbeitung unerwünschter Ereignisse unterstützen kann. Ein wichtiger Aspekt davon ist die Etablierung einer Sicherheitskultur. Die Erhebung der Sicherheitskultur findet im deutschsprachigen Raum bisher selten und fast ausschließlich durch quantitative Instrumente statt. Im Fachbereich Orthopädie und Unfallchirurgie ist in Deutschland eine hohe Zahl an bestätigten Behandlungsfehlern und Risikoaufklärungsmängeln verzeichnet. Deshalb untersucht die vorliegende Studie die Sicherheitskultur in diesem Fachbereich. Fragestellung (I) Wie nehmen Ärzte der Orthopädie und Unfallchirurgie den Umgang mit unerwünschten Ereignissen im klinischen Alltag wahr, und (II) was sind die relevanten Bestandteile einer Sicherheitskultur aus ärztlicher Perspektive? Material und Methoden Es wurden 14 Einzelinterviews mit Ärzten der Orthopädie und Unfallchirurgie geführt. Die Interviews wurden audioaufgezeichnet, transkribiert und anhand der Thematic Analysis nach Braun und Clarke und des Yorkshire Contributory Factors Framework analysiert. Zur Organisation der Daten wurde die Software MAXQDA verwendet. Ergebnisse Es konnte ein starker Einfluss der Führungskräfte auf den Umgang mit unerwünschten Ereignissen im ärztlichen Team festgestellt werden. Von Chefärzten wurde erwartet, eine gute Sicherheitskultur vorbildhaft vorzuleben, da sie durch ihr Verhalten die Handlungsweisen des Teams in sicherheitsrelevanten Situationen beeinflussen. Diskussion Der Einbezug von Chefärzten in die Entwicklung von Maßnahmen zur Verbesserung der Sicherheitskultur in der Orthopädie und Unfallchirurgie sollte aufgrund der Bedeutsamkeit hierarchischer Strukturen in Betracht gezogen werden. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00113-020-00917-0) enthält weitere Informationen zu Material und Methoden der Studie. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“. ![]()
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Affiliation(s)
- Isabel Höppchen
- Institut für Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität, Strubergasse 21, 5020, Salzburg, Österreich. .,Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland.
| | - Charlotte Ullrich
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
| | - Michel Wensing
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
| | - Regina Poß-Doering
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
| | - Arnold J Suda
- Abteilung für Orthopädie und Traumatologie, AUVA Unfallkrankenhaus Salzburg, Akademisches Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Dr. Franz-Rehrl-Platz 5, 5010, Salzburg, Österreich
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Azilaku JC, Abor PA, Abuosi AA, Anaba EA, Titiati A. Relationship between clinical governance and hospital performance: a cross-sectional study of psychiatric hospitals in Ghana. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2021. [DOI: 10.1108/ijhg-04-2020-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeClinical governance (CG) is crucial for healthcare quality of care improvement and safeguarding high standards of care. Little is known about CG in sub-Saharan Africa. The authors assessed health workers' perceptions of CG and hospital performance in Ghana's psychiatric hospitals.Design/methodology/approachA cross-sectional survey was conducted among 230 health workers across two psychiatric hospitals in Ghana. Data were collected with a structured questionnaire and analyzed with Statistical Package for Social Sciences (SPSS), version 23.0.FindingsThe majority (59.5%) of the respondents were females. The authors found that less than five in ten respondents felt that the hospitals have adopted measures to promote quality assurance (43.2%) and research and development (43.7%). However, a little above half of the respondents felt that the hospitals have adopted measures to promote education and training (57.7%); clinical audit (52.7%); risk management (50.7%) and clinical effectiveness (68.6%). The authors also found a statistically significant association between CG and hospital performance (p < 0.05).Research limitations/implicationsThere was a positive relationship between CG and hospital performance. Therefore, investing in CG may help to increase hospital performance.Originality/valueThis is the maiden study to investigate CG and hospital performance in Ghana's psychiatric hospitals and one of the few studies in Africa. This study makes a modest contribution to the global discourse on the subject matter.
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Miljković N, Godman B, Kovačević M, Polidori P, Tzimis L, Hoppe-Tichy T, Saar M, Antofie I, Horvath L, De Rijdt T, Vida RG, Kkolou E, Preece D, Tubić B, Peppard J, Martinez A, Yubero CG, Haddad R, Rajinac D, Zelić P, Jenzer H, Tartar F, Gitler G, Jeske M, Davidescu M, Beraud G, Kuruc-Poje D, Haag KS, Fischer H, Sviestina I, Ljubojević G, Markestad A, Vujić-Aleksić V, Nežić L, Crkvenčić A, Linnolahti J, Ašanin B, Duborija-Kovačević N, Bochenek T, Huys I, Miljković B. Prospective Risk Assessment of Medicine Shortages in Europe and Israel: Findings and Implications. Front Pharmacol 2020; 11:357. [PMID: 32273845 PMCID: PMC7114887 DOI: 10.3389/fphar.2020.00357] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/10/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction While medicine shortages are complex, their mitigation is more of a challenge. Prospective risk assessment as a means to mitigate possible shortages, has yet to be applied equally across healthcare settings. The aims of this study have been to: 1) gain insight into risk-prevention against possible medicine shortages among healthcare experts; 2) review existing strategies for minimizing patient-health risks through applied risk assessment; and 3) learn from experiences related to application in practice. Methodology A semi-structured questionnaire focusing on medicine shortages was distributed electronically to members of the European Cooperation in Science and Technology (COST) Action 15105 (28 member countries) and to hospital pharmacists of the European Association of Hospital Pharmacists (EAHP) (including associated healthcare professionals). Their answers were subjected to both qualitative and quantitative analysis (Microsoft Office Excel 2010 and IBM SPSS Statistics®) with descriptive statistics based on the distribution of responses. Their proportional difference was tested by the chi-square test and Fisher's exact test for independence. Differences in the observed ordinal variables were tested by the Mann-Whitney or Kruskal-Wallis test. The qualitative data were tabulated and recombined with the quantitative data to observe, uncover and interpret meanings and patterns. Results The participants (61.7%) are aware of the use of risk assessment procedures as a coping strategy for medicine shortages, and named the particular risk assessment procedure they are familiar with failure mode and effect analysis (FMEA) (26.4%), root cause analysis (RCA) (23.5%), the healthcare FMEA (HFMEA) (14.7%), and the hazard analysis and critical control point (HACCP) (14.7%). Only 29.4% report risk assessment as integrated into mitigation strategy protocols. Risk assessment is typically conducted within multidisciplinary teams (35.3%). Whereas 14.7% participants were aware of legislation stipulating risk assessment implementation in shortages, 88.2% claimed not to have reported their findings to their respective official institutions. 85.3% consider risk assessment a useful mitigation strategy. Conclusion The study indicates a lack of systematically organized tools used to prospectively analyze clinical as well as operationalized risk stemming from medicine shortages in healthcare. There is also a lack of legal instruments and sufficient data confirming the necessity and usefulness of risk assessment in mitigating medicine shortages in Europe.
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Affiliation(s)
- Nenad Miljković
- Institute of Orthopaedic Surgery "Banjica", University of Belgrade, Belgrade, Serbia
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom.,Department of Public Health and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Milena Kovačević
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Piera Polidori
- Department of Clinical Pharmacy, IRCCS, ISMETT, Palermo, Italy
| | - Leonidas Tzimis
- Hospital Pharmacy Department, Chania General Hospital, Crete, Greece
| | | | - Marika Saar
- Pharmacy Department, Tartu University Hospital, Tartu, Estonia
| | - Ioan Antofie
- Hospital Pharmacy Department, Spitalul Clinic C. F. Cluj-Napoca, Cluj-Napoca, Romania
| | - Laszlo Horvath
- Department of Pharmaceutical Surveillance and Economics, University of Debrecen, Debrecen, Hungary
| | - Thomas De Rijdt
- Pharmacy Department, University Hospitals Leuven, UZ Herestraat, Leuven, Belgium
| | - Róbert György Vida
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Elena Kkolou
- Hospital Pharmacy Department, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - David Preece
- Leeds Medicines Advisory Service, The Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, United Kingdom
| | - Biljana Tubić
- Sector for Medicinal Products, Agency for Medicines and Medical Devices of Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina.,Faculty of Medicine-Department of Pharmacy, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Joan Peppard
- Hospital Pharmacy Department, Midland Regional Hospital, Tullamore, Ireland
| | - Alicia Martinez
- Servicio de Farmacia, Hospital Universitario Infanta Sofía, Madrid, Spain
| | | | - Ratiba Haddad
- Hospital Pharmacy Department, Hôpital Antoine Béclère, Clamart, France
| | - Dragana Rajinac
- Hospital Pharmacy Department, Clinical Centre of Serbia, Belgrade, Serbia
| | - Pavle Zelić
- International Cooperation and Public Relation Department, Medicines and Medical Device Agency of Serbia, Belgrade, Serbia
| | - Helena Jenzer
- Health Division, Berner Fachhochschule Health Professions Ernährung und Diätetik, Bern, Switzerland
| | - Franci Tartar
- Department of Hospital Pharmacy, General Hospital Celje, Celje, Slovenia
| | - Gunda Gitler
- Hospital Pharmacy Department, Apotheke der Barmherzigen Brüdere. U., Linz, Austria
| | - Martina Jeske
- Pharmacy Department, University Clinic-State Hospital of Innsbruck, Innsbruck, Austria
| | - Michal Davidescu
- Faculty of Social Sciences, The Graduate School of Business Administration, Tel Aviv, Israel
| | - Guillaume Beraud
- Médecine Interne et Maladies Infectieuses, CHU de Poitiers, Poitiers, France.,Department of Public Health, Université Droit et Santé Lille 2, Lille, France
| | - Darija Kuruc-Poje
- Hospital Pharmacy Department, General hospital "dr. Tomislav Bardek", Koprivnica, Croatia
| | | | - Hanne Fischer
- Strategic Procurement and Supply of Pharmaceuticals, Amgros I/S, Copenhagen, Denmark
| | - Inese Sviestina
- Hospital Pharmacy Department, Children's Clinical University Hospital, Riga, Latvia
| | - Gordana Ljubojević
- Department of Physical Medicine and Rehabilitation "Dr Miroslav Zotović", Banja Luka, Bosnia and Herzegovina
| | - Anne Markestad
- National Center for Medicine Shortages in Hospitals, Oslo universitetssykehus HF, Nydalen, Norway
| | - Vesna Vujić-Aleksić
- Certification Department, The Republic of Srpska Agency for Certification, Accreditation and Quality Improvement in Health Care, Banja Luka, Bosnia and Herzegovina.,Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Lana Nežić
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Anica Crkvenčić
- Community Pharmacy Department, Pharmacy "Biljana", Banja Luka, Bosnia and Herzegovina
| | | | - Bogdan Ašanin
- Department of Surgery, Department of Medical Ethics, Medical Faculty of the University of Montenegro, Podgorica, Montenegro
| | - Nataša Duborija-Kovačević
- Department of Pharmacology and Clinical Pharmacology, Medical Faculty of the University of Montenegro, Podgorica, Montenegro
| | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Branislava Miljković
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia
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Zarei E, Karimi S, Mahfoozpour S, Marzban S. Assessing hospital quality management systems: evidence from Iran. Int J Health Care Qual Assur 2019; 32:87-96. [PMID: 30859868 DOI: 10.1108/ijhcqa-11-2017-0208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE A quality management system (QMS) is defined as interacting activities, methods and procedures used to monitor, control and improve service quality. The purpose of this paper is to describe the QMS status using the Quality Management System Index (QMSI) in hospitals affiliated to Shahid Beheshti Medical Sciences University in Tehran, Iran. DESIGN/METHODOLOGY/APPROACH In this cross-sectional study, 28 hospitals were investigated. A validated 46-item questionnaire was used for data collection. Data were analyzed using descriptive statistics, Pearson correlation, independent student's t-test and regression analysis. FINDINGS The mean QMSI score was 18.4: 15.3 for public and 20.9 for non-public hospitals ( p=0.001). The lowest (1.96) and the highest (2.14) scores related to "Quality policy documents" and "Quality monitoring by the board," respectively. The difference between public and non-public hospitals was significant in all nine QMSI dimensions ( p=0.001). The QMSI score was higher in non-public and small hospitals than in public and large ones ( p=0.05). ORIGINALITY/VALUE Most QMS studies come from developed countries, and there is no systematic information about the mechanisms and processes involved in implementing QMS in developing countries like Iran. This is the first study on Iranian hospital QMS using a newly developed tool (QMSI), and results showed that QMS maturity in these hospitals was relatively good, but the non-public hospitals status (private and charity) was far better than public hospitals.
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Affiliation(s)
- Ehsan Zarei
- Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Soghra Karimi
- Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Soad Mahfoozpour
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Sima Marzban
- Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences , Tehran, Iran
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Schwappach DLB, Häsler L, Strodtmann L, Siggelkow A. [Morbidity and mortality conferences in Lower Saxony: Implementation status and further development needs]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2018; 135-136:34-40. [PMID: 30007770 DOI: 10.1016/j.zefq.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/07/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Morbidity and mortality conferences (M&MC) are a tool to foster individual and organizational learning in hospitals, and they are important to improve patient safety. So far, no data has been available about the implementation of M&MC in Lower Saxony and the characteristics of M&MCs. The aim of this study was to assess the status quo of M&MC in Lower Saxony and to identify the potential for improvement. METHODS A cross-sectional survey study was conducted among chief physicians in surgery, internal medicine, anesthesiology/intensive care, gynecology/obstetrics and pediatrics (response rate: 50 %). RESULTS Apart from technical topics (37 %), the main issues addressed are process (92 %) and teamwork (64 %) issues. The results also show a strong heterogeneity in terms of structures and processes of implemented M&MC in Lower Saxony. Despite a high level of satisfaction (85 %) and perceived effectiveness (93 %), most participants see potential for improvement of "their" M&MC (58 %). CONCLUSION Chief physicians in Lower Saxony report both a high level of acceptance and the need for further improvement of the M&MCs, which represents good preconditions for further development towards effective M&MCs.
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Affiliation(s)
- David L B Schwappach
- Stiftung Patientensicherheit Schweiz, Zürich, Schweiz; Institut für Sozial- und Präventivmedizin (ISPM), Universität Bern, Schweiz.
| | - Lynn Häsler
- Stiftung Patientensicherheit Schweiz, Zürich, Schweiz
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Klingenberg A, Nöst S, Szecsenyi J. [Assessment of the severity of postoperative complications from the patient and doctor perspective]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2018; 134:27-34. [PMID: 29673802 DOI: 10.1016/j.zefq.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 03/13/2018] [Accepted: 03/18/2018] [Indexed: 10/17/2022]
Abstract
AIM OF THE STUDY This study compares doctors' and patients' assessments of the severity of postoperative complications reported by patients. Within the context of quality assurance and patient safety, the study aims to contribute to developing instruments to include patients' views for measuring postoperative complications. METHODS In a questionnaire development study 474 patients who had undergone different kinds of surgery were given a questionnaire and asked whether postoperative complications occurred, and if so, to describe these complications in free text and assesses their severity as "slight, temporary" or "extensive". In an additional study, the patients' written descriptions of their complications were presented independently to two doctors (general practitioner [GP], orthopaedic surgeon) who were asked to assess the severity from their point of view. The physicians were not aware of the patients' or the other physician's assessments. RESULTS 23.5 % of the patients participating in the survey reported postoperative complications in the questionnaire. Feedback from 80 of these patients included sufficient information for data analysis concerning the study's aim, including the description of their complication in free text. 47 (58.7 %) of these patients assessed their postoperative complications as being "slight, temporary", 33 (41.3 %) as being "extensive". The doctors, on the other hand, assessed the severity of the complications described by the patients much less often as "extensive" (GP: 20.0 %, orthopaedic surgeon: 11.3 %). In only 4 (12.0 %) of the 33 cases where the patient chose "extensive" both doctors also chose the assessment item "extensive". In 10 cases (30.3 %), one doctor's "extensive" assessment matched the patient's assessment, and in 19 cases (57.6 %) the patients but none of the doctors assessed the complications as being "extensive". There was a higher correlation between the GP's and the patients' assessments than between the orthopaedic surgeon's and the patients' ratings. Examples of patients' descriptions of their postoperative complications in free text as well as the corresponding assessments of patients and doctors are presented. CONCLUSIONS Patients' views and assessments of postoperative complications are different from doctors' views. Adequate instruments for measuring the occurrence and severity of postoperative complications should be developed bringing the patients' perspectives into the doctors' assessments. Also, it might be useful to include questions addressing information received pre- and postoperatively about the expected postoperative course as well as communication with patients in the case of complications.
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Affiliation(s)
- Anja Klingenberg
- aQua-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen, Göttingen, Deutschland.
| | - Stefan Nöst
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
| | - Joachim Szecsenyi
- aQua-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen, Göttingen, Deutschland; Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
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